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Psychiatr Serv. 2011 Nov;62(11):1346-52. doi: 10.1176/appi.ps.62.11.1346.

Intensity of outpatient monitoring after discharge and psychiatric rehospitalization of veterans with depression.

Author information

  • 1Ann Arbor Center of Excellence, Serious Mental Illness Treatment Resource and Evaluation Center, U.S. Department of Veterans Affairs, Ann Arbor, Michigan, USA. myrakim@umich.edu

Abstract

OBJECTIVE:

This study assessed whether increased frequency of clinical monitoring during the high-risk period of 12 weeks after discharge from a psychiatric hospitalization reduced subsequent rehospitalization in a national cohort of Veterans Health Administration patients receiving depression treatment between 1999 and 2004.

METHODS:

A case-control design was used. Patients who had at least two inpatient psychiatric hospitalizations were identified (case group, N=17,852) and then individually matched with up to two patients who also had been discharged from psychiatric inpatient settings but were not rehospitalized for the number of days between the case-group patient's discharge and subsequent rehospitalization (N=35,511).

RESULTS:

Covariate-adjusted relative risk (RR) did not show an association between increased monitoring and subsequent psychiatric hospitalization, but there was a significant negative interaction between monitoring and a comorbid substance use disorder diagnosis (p<.001). Increased monitoring was positively associated with rehospitalization of patients without a substance use disorder, whereas increased monitoring was not associated with increased risk of rehospitalization of those with a comorbid substance use disorder. The RR of rehospitalization associated with a weekly monitoring visit (12 visits per 84 days) versus no monitoring visit was 1.14 for patients without a substance use disorder, whereas the RR was reduced to .94 for patients with a substance use disorder.

CONCLUSIONS:

Increased outpatient monitoring during the high-risk period after discharge appears to have a modest protective effect on rehospitalization among depressed patients with a comorbid substance use disorder.

PMID:
22211215
[PubMed - indexed for MEDLINE]
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